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高分级颅内动脉瘤破裂出血的早期血管内治疗

陈荣华,宣井岗,彭亚,王穗暖   

  1. 江苏省常州市第一人民医院神经外科
  • 收稿日期:2011-03-10 修回日期:2011-07-21 出版日期:2012-02-15 发布日期:2012-02-15
  • 通讯作者: 陈荣华

Endovascular treatment of poor grade ruptured aneurysms：a review of 36 cases

  • Received:2011-03-10 Revised:2011-07-21 Published:2012-02-15 Online:2012-02-15

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摘要： 自发性蛛网膜下腔出血（aSAH）占脑卒中的5%，而其中75%是由于颅内动脉瘤破裂出血引起，其中高分级颅内动脉瘤占20%～30%。随着血管内介入治疗的发展，动脉瘤性蛛网膜下腔出血的病死率已经明显下降至20%，死亡患者中超过90%为入院时的高分级动脉瘤患者。本文回顾性分析我院神经外科自2008年6月—2010年8月收治的36例入院时Hunt-Hess分级为Ⅳ、Ⅴ级患者应用弹簧圈介入栓塞动脉瘤的临床资料。

关键词: 颅内动脉瘤, 蛛网膜下腔出血, 栓塞, 治疗性, 预后

Abstract: Objective To investigate the therapeutic effects of endovascular management for aSAH caused by ruptured aneurysm of poor grade(Hunt-Hess grade,4-5). Methods we retrospectively 36 patients with poor grade aneurismal SAH admitted to our hospital ,of which 28 were Hunt-Hess Grade Ⅳ and the rest grade Ⅴon admission. Early endovascular treatment was carried out in these patients ,the data of these patients including patient demographics, morphologic features of the aneurysms ,treatment results and follow-up data were collected and analyzed .Results The early interventional procedures were completed in all patients ,Angiography immediately after the treatment showed that the aneurysm of the total 32 patients were obliterated ,After a follow up period of 3- 18 months ,good prognosis was 55.5%(20/36),the poor prognosis was 13.8%(5/36),and the mortality rate was 8.39%(3/36). Conclusion Patients with poor grade aneurismal SAH should be treated aggressively; Interventional embolization by using detachable coils is a safe ,mini-invasive and effective therapy with few complications, and also can receive satisfying prognosis.